Legitimate opioid use for pain management
People across the country who are dealing with serious acute and chronic pain issues are becoming increasingly alarmed and confused about whether their opioid prescriptions will remain available.
If you are someone who’s looking at a major surgery, such as spinal fusion or a total knee replacement and resulting acute pain; are dealing with chronic pain, from conditions such as Crohn’s disease or rheumatoid arthritis; or are in palliative care after battling cancer, you should know there’s a lot of misinformation out there.
What do credit cards, hockey helmets, kids’ toys, trashcans, toothpaste, deodorants and shaving creams have in common? They all could contain triclosan, which for a long time has been touted as an effective antimicrobial (a bacteria slayer). Then, a few years ago, it was discovered that triclosan could contribute to the development of antibiotic-resistant germs, or superbugs, and the Food and Drug Administration banned its use in hospital cleaning agents and consumer soaps.
Unfortunately, the FDA can’t regulate paints, clothes, sporting equipment or furniture. That’s why you still can find triclosan in those products and in anything else that advertises itself as having “antimicrobial properties.”” So it continues to cause trouble, both in the biosphere and for you.
Most recently, research published in the journal Antimicrobial Agents & Chemotherapy revealed how triclosan can help bacteria become more resistant to antibiotic treatments for diseases such as urinary tract infections. Researchers from Washington University in St. Louis found that repeated triclosan exposure makes bacteria able to survive “normally lethal concentrations of antibiotics,” including the old staple ciprofloxacin (Cipro). Previous research has found that triclosan alters hormone regulation and could be harmful to your immune system.
Be on your guard for clothing, house paints and toys, etc., that claim to control or kill germs and bacteria. There’s a good chance they contain triclosan. Manufacturers are not required to put that information in their labeling.
Tip: Washing your hands thoroughly with plain soap and water is just as effective at getting rid of unwanted bacteria as so-called antimicrobials.
Unfortunately, doctors, pharmacists and patients can fall victim to faulty reporting and make decisions based on what they believe are facts but are half-truths instead. That’s why we’re going to set out the current information, so you know — or can find out — where you really stand.
We know it’s not easy to be your own best patient advocate when you are in pain, but you need to be aware of what your state and your insurance plan allow and be able to clarify that information for your doctor or surgeon if the need arises. To discover what rules apply to you, check out Affirm Health’s State by State Opioid Prescribing Guidelines website (www.affirmhealth.com). Also, get in touch with a certified pain management specialist who you can work with to manage your pain.
HOW NEW LAWS AFFECT YOU
Here’s the scope of the new regulations that are cropping up to control opioid abuse.
Colorado’s 2018 Senate Bill 18-22 Clinical Practice for Opioid Prescribing is similar to many state bills across the country. At face value it looks like it limits a patient’s initial prescription of an opioid to a seven-day supply, “if the prescriber has not written an opioid prescription for the patient in the last 12 months.” But if you read on, you’ll see the bill continues: “The prescriber may exercise discretion in including a second fill for a seven-day supply. These limits do not apply, if, in the judgment of the prescriber, the patient … is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.” So you’re able to get the pain management you need, but your pain management specialist, your surgeon and YOU need to know the local laws, and you want to make sure everyone is aware of the paperwork it takes to move forward!
Fortunately, on a national level, the Food and Drug Administration and others are beginning to recognize that while a person may become dependent on opioids if they are used to control even acute pain, that patient wants to stop taking them (most people do!). A pain management specialist can effectively work with the patient to taper off the medication as the pain eases. Rapid forced tapering (abrupt cessation) of opioids torments patients and can lead to use of illicit pain relievers, risking death from fentanyl exposure and even suicide.
ALTERNATIVES TO OPIOID PAIN THERAPY
There has been significant progress made in the past few years concerning the amount of opioids being prescribed. According to a report published in JAMA Internal Medicine, “Since January 2017, the amount of MMEs (that’s a measure of morphine milligram equivalents applied to opioids) prescribed has declined 19.4 percent and the number of patients receiving buprenorphine, an FDA-approved treatment for opioid withdrawal, has increased 21 percent.” The National Survey on Drug Use and Health says the number of Americans reported to be misusing pain relievers has “significantly decreased.”
In large part this is due to a raised awareness of a combination of 1) food choices; 2) physical, occupational and exercise therapy; 3) cognitive behavioral therapy, as well as routine stress management practice; and 4) nonopioid pain medications that may be even more effective than opioids in the long run at reducing pain. So find out what regulations are in effect in your state, and work with all your doctors to develop a pain management plan that incorporates these other pain management techniques.
Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email questions to youdocsdaily@sharecare.com.
